Background: Apheresis procedures require adequate vascular access to achieve adequate inlet flow rates. Central dialysis-type catheters are often used in apheresis, despite their multiple risks. Peripheral venous access is a safe and effective option for many patients.Aim: We previously demonstrated that ultrasound guidance reduces central venous catheter use in apheresis patients; however, no validated criteria for preprocedural evaluation of peripheral veins exist. Here, we hypothesized that ultrasound-based criteria could predict the adequacy of a peripheral vein for apheresis procedures.Patients/Methods: In this pilot cohort study, we reviewed the procedural outcomes for 50 cases of peripheral venous procedures that used our ultrasound-based criteria.Results: Of the procedures that met our criteria, 96% (46/48) were successfully completed. Overall, our criteria had 100% sensitivity, 50% specificity, 96% positive predictive value, and 100% negative predictive value. Conclusion: Our criteria justify an evidence-based ultrasound-guided standard for evaluation of peripheral venous access for apheresis procedures.
Drug-induced hypersensitivity syndrome (DIHS; also known as drug reaction with eosinophilia and systemic symptoms, or DRESS) is a rare, potentially life-threatening condition that typically presents 2–8 weeks after drug exposure with fever, rash, organ dysfunction, and lymphadenopathy. Here, we describe the case of an 18-year-old African American female who presented with cervical lymphadenopathy, fevers, and a macular rash. A PET scan showed diffuse hypermetabolic lymphadenopathy suggestive of lymphoma, with involvement of the spleen and kidneys. The clinical history, imaging, and biopsy findings initially raised concern for a malignant process, with a differential diagnosis including classic Hodgkin's lymphoma and T-cell lymphoma. However, the morphologic and immunophenotypic features were not entirely typical for those diagnoses. The patient was ultimately diagnosed with DIHS after it was learned that she recently had been treated with minocycline, a medication previously implicated in causing DIHS.
We present a case of a 15‐year‐old female who was admitted in a comatose state with no spontaneous respiratory effort and absence of brainstem reflexes after cyclobenzaprine ingestion. Due to severe presentation and recent ingestion of high plasma protein binding medication with long half‐life, therapeutic plasma exchange (TPE) was performed and resulted in full neurological recovery. This case explores the role of TPE as an effective treatment option for life‐threatening cyclobenzaprine overdose. TPE is generally beneficial for drugs that have a low volume of distribution and high plasma protein binding. Cyclobenzaprine is known to have a relatively high volume of distribution. However, in the case of drug intoxication with relatively high‐volume distribution, high protein binding, and long half‐life, TPE could be effective if it is conducted promptly.
High-volume blood banks at academic hospitals and medical centers have increased demands for utilization review, which can be manual and laborious. Every blood bank’s utilization review program is unique and depends on available personnel, staffing, and access to electronic medical records. A standardized, automated workflow for utilization review can reduce error and subjectivity and maximize efficiency. A customizable query that can accommodate different product utilization review criteria and is compatible with mainstream EMRs such as Epic is a valuable clinical tool for many practice settings. Furthermore, an efficient workflow that minimizes manual technician review and reduces provider fatigue can provide increased cost savings while maintaining compliant utilization review practices. Modern versions of Microsoft Excel, the most used data spreadsheet program worldwide, incorporate new features for data collation and analysis, namely, Power Query. Power Query enhances Excel’s capabilities for self-service Business Intelligence (BI). We introduce an approach for Better Blood Bank Administration Review and Bridging Epic using QUEries (BB-BARBEQUE) and demonstrate a preliminary version of the workflow that enables ordinary end users, such as pathology residents, to conduct utilization reviews more easily and efficiently. The workflow is designed to dynamically capture product utilization data that are generated through Epic SQL reporting into a user-friendly spreadsheet format. The data are filtered by using customizable queries to capture blood product requests that are most likely to yield actionable results. Our reviews included blood product requests for units of packed red blood cells, platelets, fresh-frozen plasma, and cryoprecipitate, as well as extensive associated metadata, including the ordering unit, patient identifiers, provider names, dates and times of product use and laboratory collection, and most recent laboratory values for hemoglobin, platelet count, INR, and fibrinogen. We compare this approach to the previous, manual workflow. Incidences deemed inappropriate for product use are tracked and compared with both approaches, through a metric designed to evaluate the number of successful provider contacts, either through a form letter or telephone call. We also provide preliminary comparisons of technician time saved by adopting this procedure compared to the previous approach. Overall, we show that automation of key steps in the utilization review procedure can significantly increase efficiency while improving the end-user experience, and we demonstrate an end-user product that is translatable to many institutions using an Epic EMR backend.
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